MEDICARE: CCLAKEVIEW CILA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	04040	IL

General Provider Information

NPI Number	:	1811203813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCLAKEVIEW CILA

Provider Business Mailing Address
First Line	:	3225 N SHEFFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2210
Country	:	US
Telephone Number	:	773-549-5886
Fax Number	:	773-549-3265

Provider Business Practice Location Address
First Line	:	732 W GRACE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4114
Country	:	US
Telephone Number	:	773-549-5886
Fax Number	:	773-549-3265

Authorized Official
Title or Position	:	CONTROLLER
Name	:	DANIEL P KANTER
Credential	:
Telephone Number	:	773-549-1102

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	06/28/2011

Similar Medicare Providers

1588742936 — DANIEL R. KOZICKI, DDS, PC
Practice Location Address:

4114 W 63RD ST
CHICAGO, IL
60629-5008

Practice Phone: 773-581-0811
Practice Fax: 773-581-1530

1801975834 — MS. LISA MARIE CROWE PT
Practice Location Address:

6734 N ASHLAND AVE
CHICAGO, IL
60626-4114

Practice Phone: 773-973-7473
Practice Fax:

1902921299 — MR. JAMES THEODORE GREEN SR. LCPC
Practice Location Address:

7400 S RACINE AVE , SUITE 101
CHICAGO, IL
60636-4114

Practice Phone: 773-874-9715
Practice Fax: 773-874-9715

1083867600 — DR. DANIEL R. KOZICKI D.D.S.
Practice Location Address:

4114 W 63RD ST
CHICAGO, IL
60629-5008

Practice Phone: 773-581-0811
Practice Fax: 773-581-1530

1528319142 — ELIZABETH DANA MEYER MA
Practice Location Address:

4618 S CHICAGO ST
SEATTLE, WA
98118-4114

Practice Phone: 206-853-7976
Practice Fax:

1942698295 — MRS. KATHLEEN TERESE QUACKENBUSH
Practice Location Address:

2014 W 22ND PL , UNIT 1
CHICAGO, IL
60608-4114

Practice Phone: 630-429-6869
Practice Fax:

Directions to “CCLAKEVIEW CILA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.